Perth Community Stroke Study - Perth

Description:

The Perth Community Stroke Study is an observation, long-term follow-up study of patients who had a stroke from 1989-1990 in Perth, Australia. The study was designed to predict long-term survival among different subtypes of stroke.

Hypothesis:

To develop a model for predicting survival during 1 year after acute stroke.

Study Design

Study Design:

Patient Populations:

Episode of acute cerebrovascular disease that occurred between 02/20/1989 and 08/19/1990.
Resident of Perth, Australia.
Final diagnosis of stroke according to the WHO definition ("rapidly developing symptoms and/or signs of focal, and at times global, loss of cerebral function, with symptoms lasting >24 hours or leading to death with no apparent cause other than that of vascular origin").
First ever stroke.

Primary Endpoints:

28 day, 1-year and 5-year mortality

Secondary Endpoints:

Cause of death

Drug/Procedures Used:

Stroke cases were detected from several sources:
notification from general practicioners;
admission to acute care hospitals, rehabilitation centers, and nursing homes;
prospective surveillance of hospital morbidity data;
review of Coroner and Bureau of Statistics death reports.

Principal Findings:

Mortality was 24% at 28 days, 38% at 1 year, and 60% at 5 years.
Among the different subtypes of stroke, 1-year mortality was 6% for boundary zone infarction, 16% for lacunar infarction, 42% for subarachnoid hemorrhage, and 46% for primary intracerebral hemorrhage.
The most common cause of death in the first year was the index or recurrent stroke (58%) and pneumonia (22%); beyond the first year was cardiovascular disease (41%) and the index or recurrent stroke (15%).
A predictive model was developed containing five baseline variables that were independent predictors of death within 1 year: coma (RR, 3.0), urinary incontinence (RR, 3.9), cardiac failure (RR, 6.5), severe paresis (RR, 4.9), and atrial fibrillation (RR, 2.0).
The risk of death beyond the first year was approximately 10% per year, which is approximately 2-fold greater than that expected among the general population of the same age and sex.

Interpretation:

Five clinical measures were identified that reflect the severity of the neurological deficit and associated cardiac disease at onset (coma, urinary incontinence, cardiac failure, severe paresis, and atrial fibrillation) and independently predict death by 1 year.
Assessment of these risk may help to direct patient management following stroke.
Since the most common cause of 5-year death is cardiovascular disease, long-term survival after stroke may be improved by early implementation of strategies for preventing subsequent cardiovascular events.